美国印第安人的心脏病发病率下降了一代人

Heart disease among American Indians in three regions has declined with each generation over the past 25 years, 在此期间，死于心血管疾病的男性越来越少, according to new findings in the largest and longest-running study of the community.

心脏病是美洲印第安人死亡的主要原因. 虽然他们占人口的比例不到2%，但却占美国总人口的18%.S. 心脏病导致的死亡.

这项新研究表明，协同努力预防心脏病是有效的, 克莱玛·穆勒说, 这项研究的主要作者. Participants in the study were given medical referrals to manage their cardiovascular risk factors over the course of the study.

That suggests the "concerted effort to identify people with risk factors for heart disease and to aggressively treat these risk factors can make an important difference in these high-risk and underserved populations," said Muller, 医学院的助理教授, 华盛顿州立大学. 这项研究于10月10日发表. 25 in the 美国心脏协会杂志.

Muller and her team analyzed data from the Strong Heart and Strong Heart Family studies, 其中包括三组男性和女性, 出生于1915年至1984年之间, 生活在西南和南北平原地区. These groups make up the largest, long-term database of cardiovascular disease in American Indians. Participants were enrolled from 1989-1990 and again from 2000-2003 and followed at five-year intervals until 2013.

All participants were given information about cardiovascular disease and its risk factors. 在后续研究考试期间, 如果有高血压等危险因素或状况, 检测出糖尿病或心脏病, 与会者被转介接受治疗.

Muller and her team compared the incidence and death from cardiovascular disease in 5,来自两项研究的627名男女. They found rates of new cases of cardiovascular disease had declined over a generation. 死于心脏病的男性人数下降得更多, 而女性的心脏病患病率下降得更多.

“这是非常令人兴奋的消息。. David Lee Gordon, professor and chair of neurology at the University of Oklahoma. 他没有参与这项研究. The decreases parallel national trends that include a growing focus on controlling blood pressure and other efforts to control risk factors, 比如给高胆固醇患者开他汀类药物.

"We don't know if they were actually going to the clinics and getting their blood pressure and cholesterol checked, 但这表明发生了一些积极的事情. It means if you can take charge of life – check under your hood while you still feel good – you have a great chance of decreasing your risk."

It's unclear why men were seeing an improvement in mortality rates and not women, Muller said. One possibility is women who do get cardiovascular diseases are getting sicker, she said.

That could be because the rate of diabetes – a major risk factor for heart disease – was climbing dramatically among American Indians when people were being enrolled in the study. "And people may have more health issues than they did before that would compound the problem," Muller said.

American Indians now have the highest prevalence rate for diabetes of all racial and ethnic groups in the country.

但为什么男性和女性会受到不同的影响尚不清楚. Muller said the difference also might be due to inability to statistically detect mortality improvements in women simply because fewer women than men die from heart disease, 未来的研究应该更仔细地研究女性身上发生了什么.

“也许我们只是没有在女性身上诊断和检测到这一点," said Muller, 讨论不同影响下的另一种可能性. "You won't have the same preventive efforts applied if you don't detect the risk factors in the first place."

Dr. Sara Selig, who specializes in American Indian health inequities and is an associate physician in the Division of Global Health Equity at Brigham and Women's Hospital, said the study was good news for a population that has faced racist practices and policies that greatly impact rates of disease.

尽管面临这些挑战," said Selig, 谁没有参与这项研究, “以社区力量为基础的解决方案, cut across the many systems that impact the health of a community and that begin earlier in the life course have the greatest potential to impact health outcomes later in life."

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